Health New Zealand

Māori Health
Authority
Update on the National Operating
Model and High-Level Structure

April 2022
Contents
1. Foreword from the CEs
2. Overview of how we will
change to deliver on our
purpose
3. Information on Health New
Zealand functions
4. Information on Māori
Health Authority functions
5. Putting it together – system
shifts and how the two
organisations work
together
6. Next steps – working
groups on Operating Model
and selection and
appointment process
 A message from the Chief Executives
This paper sets out the new national leadership team for Health New Zealand (HNZ), the Māori Health
Foreword from Authority (MHA) and the functions that will fall within each business unit at a high level. This paper also sets
the CEs out how we see regional and local delivery working. Importantly, this paper describes our approach to how
HNZ and MHA will partner to improve Māori health outcomes and eliminate health inequities. Equity has to
be designed into the system – we can’t rely on the goodwill of individual teams or people.

Fepulea’i Margie Apa
Chief Executive
interim Health New Zealand
Riana Manuel
Chief Executive
interim Māori Health Authority
As we write this document, we are 10 weeks into our roles with less than 10 weeks to likely legislation
enactment. While national leadership roles are determined, there is room for co-design and engagement on
how we organise ourselves at regional and local levels. Sector-wide working groups on some functions will be
established with leaders (and some external experts to challenge us) to input into the development of
operating models that align with our overall transition objectives – to simplify the way we work, unify our
teams, make visible consumer voices and embed enablers of equity and sustainability.
Our healthcare networks are facing into one of the most difficult winter periods we are likely to experience,
with a possible resurgence of COVID-19 and other viral illnesses that may peak over the same period. We are
aiming to begin the first few steps of transition in the remaining months of this calendar year at a time when
many parts of our workforce have had limited respite over the last two years of multiple COVID-19 waves.

In implementing Cabinet’s health reforms to realise the five system shifts, we aim for minimal disruption to
frontline care for people, their whānau and communities. This will be achieved by ensuring the leadership and
expertise of DHB CEs is secured until the end of September 2022, or longer by agreement, to support and
implement the new operating model. Reporting lines for DHB CEs will revert to the HNZ CE from 1 July 2022.
Between now and 30 September 2022, we aim to complete 12 weeks of ‘sprints’ of operating model
development with existing leaders, to ensure we capture the best of opportunities while managing the risks of
discontinuity. These sprints will further refine our operating model as a single national entity.

Within this document we have made a number of suggestions and ideas around current thinking of the
direction of travel and potential reporting lines of existing roles and function across the system into this new
national leadership team. We would like these ideas to be considered as part of the co-design process and
acknowledge that any changes to an individual role will be considered at the point when a formal change
management process is initiated.

Your health and wellbeing matters – we will pace change in a way that aims to make best use of the talent and
skills we have. We thank you in anticipation for your participation.

Fepulea’i Margie Apa and Riana Manuel

HNZ MHA Operating Model and High level Structure | Update | 3

 Describing the establishment and transition of the new entities
This document describes the first phase of
establishment and transition for the 2nd tier national
What is the leadership team and regional leadership roles within
HNZ and the MHA.
purpose of this
document? We aim to establish and appoint to these roles
before 1 July, or have acting arrangements in place.
This will enable the transfer of functions and
reporting lines across the Ministry of Health, Te
Hiringa Hauora, District Health Boards and Shared
Services Agencies (SSAs) into new leadership
structures within HNZ and MHA during July –
September 2022. Some functions may take longer to
shift into the new leadership arrangements, and
others will have interim leadership arrangements,
while specific parts of the operating model continue
to be developed post 1 July. Working groups are
already in place for National Procurement/Supply
and Data & Digital functions.
This document has been developed for those
whose employer will change from 1 July. This
includes:
• All staff employed by the Ministry of Health in
functions that have transferred, or are about to
transfer, to HNZ or MHA;
• All staff employed by District Health Boards and
their SSAs; and
• All staff employed by Te Hiringa Hauora (Health
Promotion Agency).
This document signals further consultation and
engagement with staff and/or their representatives
that are likely to be affected by these changes in
future phases of transition. We will work consistently
with expectations agreed in MECA and other existing
change documents.
This document contains six sections:
Section 1
Overview of how we will change to deliver on
our purpose
From transition to transformation – an
Section 2 overview of our approach to building our
operating model
Information on HNZ functions
• Section 3.1 Delivery Team Leadership
Section 3 • Section 3.2 Clinical Team Leadership
• Section 3.3 Enabling Team Leadership
• Section 3.4 Office of the Chief Executive
Section 4 Information on MHA functions
Putting it together – system shifts and regional
Section 5
working
Next Steps – working groups on operating
Section 6
model and selection and appointment process
This document does not:
 Repeat the context for reform – however, links to
these papers can be found here.
 Outline a blueprint for how HNZ and MHA will work
with the wider sector. There is more work to do on
this approach.
 Detail how we will fulfil our obligations to being
effective partners in Te Tiriti – this work is to be
done in partnership with Iwi-Māori Partnership
Boards and regional functions that are currently
being established.
 Detail how we will achieve equity, but it describes
the roles and functions of teams and the
expectations of their work to enable gains in equity.
The above points are either currently being or will be
progressed with the appropriate partners and stakeholders
HNZ MHA Operating Model and High level Structure | Update | 4
1. Overview
The Government’s vision is to
build a healthcare system that
achieves pae ora / healthy
futures for all New Zealanders.
An Aotearoa where people live
longer in good health and have
improved quality of life, and
where there is equity in
outcomes for Māori and
communities with inequities.
The outcomes we are trying to achieve
We want to build a healthcare system that works
collectively and cohesively around a shared set of
values and a culture that enables everyone to bring
their best to work and feel proud when they go home
to their whānau, friends and community. In doing so,
the totality of the reforms are expected to achieve
five system shifts.
These are:
1 The health system will reinforce te Tiriti o
Waitangi principles and obligations.
2 All people will be able to access a
comprehensive range of support in their
local communities to help them stay well.
When people need emergency or specialist
3 health and wellbeing and have meaningful
healthcare this will be accessible and high
quality for all.
4 Digital services will mean that many more
people will get the care they need in their
homes and local communities.
Health and care workers will be supported,
5
valued and well trained for the future health
system.
The improvements in outcomes we aim to prioritise
that will operationalise the way system shifts are
achieved include:
 Equity: tackling the gap in access and health
outcomes between different populations and
areas of New Zealand, with a particular focus on
outcomes for Māori, Pacific peoples and
disabled people.
 Sustainability: embedding population health as
the driver of preventing and reducing health
need, and promoting efficient and effective care.
 People and whānau-centred care:
empowering all people to manage their own
control over the services they receive, and
treating people, their carers, and whānau as
experts in care.
 Partnership: ensuring partnership with Māori in
leading the design and delivery of services at all
levels of the system, and empowering all
consumers of care to design services that work
for them.
 Excellence: ensuring consistent, high quality
care in all areas, and harnessing clinical
leadership, innovation, and digital and new
technologies to continuously improve services.
HNZ MHA Operating Model and High level Structure | Update | 5
What agencies will be established and what is their role?
The establishment of entities is dependent Key components of the reformed health system
on the Pae Ora Bill being passed
Minister of The Public Health Agency
• As it stands, the Bill is set to come into effect from 1 Health and a new expert advisory
July 2022, or at another date specified in the final The Ministry of Health will committee on public health
statute. The legislation will set the context for the strengthen its role as the will be established within
chief steward of the
functions of the entities displayed in the diagram to Ministry of the Ministry of Health
system
the right. Health
Health New Zealand Public Health The Māori Health
• Cabinet has agreed to a number of functions and replaces 20 district health
Health NZ
Agency Authority is being
responsibilities at a national, regional and local level boards as the operational established to drive a
lead for health services, National Public MHA
for HNZ. HNZ will work alongside the MHA at a Health Service
focus on hauora
undertaking planning and
regional level through four regional divisions. District Māori in the system,
commissioning, monitoring working jointly with
funders, localities and Iwi-Māori Partnership Boards performance and driving Regional Regional the Ministry of Health
will ensure communities have access to primary and innovation. and Health NZ to
community care based on their aspirations and
The National Public agree strategies, plans
needs. District
and priorities
Health Service, alongside
Iwi-Māori
the Public Health Agency,
Partnership
will strengthen health Iwi-Māori Partnership
Boards
The role of the Ministry of Health protection and health Boards, as the tangata
Localities
promotion, and improve and whenua partner, will be
• The Ministry of Health (the Ministry) will remain the public health knowledge, hospitals involved in planning at a
chief steward of the health system and lead advisor research and intelligence, locality level and ensure the
to the Government on matters relating to health. bringing together the 12 voices of whānau and
This includes a renewed focus on stewardship, existing Public Health mātauranga Māori are visible
Units. Hospital and specialist
strategy, policy, regulation and establishing a new services will be planned and
across the health system
regime for system and outcome monitoring. With Primary and community care in
managed by Health NZ as part
regard to Hauora Māori, the Ministry will co-develop the future system will be reorganised
of a coherent network
policy advice with the MHA. to serve the communities through
‘localities’
• The commissioning of frontline services now sits in
the operational parts of the system. However, the
Ministry may commission some national
interventions in line with its strategic role, in
agreement with HNZ and the MHA (e.g. national
campaigns).

HNZ MHA Operating Model and High level Structure | Update | 6

What will be in place from Day 1?
Day 1 for the reformed system is intended to To date, HNZ and MHA have been focused on transitioning and setting up platforms for
be 1 July 2022 transformation. However, transformation won’t occur straight away. Listed below are some
of the key responsibilities HNZ and the MHA assume on Day 1 that signal the beginning of
• Day 1 for the reformed system is intended to be 1 July 2022. this transformation journey.
This is when new legislation will replace the New Zealand
Public Health and Disability Act 2000 and formally establishes
HNZ and the MHA. On this day, the District Health Boards Health New Zealand Māori Health Authority
(DHBs) and Te Hiringa Hauora / Health Promotion Agency will Some key Day 1 Responsibilities Day 1 Responsibilities
be legally disestablished and their staff, contracts, assets and
liabilities, including in relation to SSAs and organisations • Planning, delivery and • Hauora Māori strategy and policy in partnership
owned by individual DHBs, will transfer to HNZ. Shared commissioning of publicly-funded with the Ministry of Health
services and other DHB-owned organisations will transfer to health services
HNZ ownership as whole organisations. • Monitoring and realisation of equitable health
• Day-to-day operational planning and outcomes for Māori
• In the new system, DHB Chief Executives will continue to management of hospital and
provide leadership and expertise, offering transitional specialist services • Development of the Māori health workforce and
leadership as part of HNZ from 1 July to 30 September 2022. sector leadership strategies and work
During this time, we will continue to confirm and shift • Commissioning primary and programmes, partnering with and supporting
reporting lines to HNZ and MHA for functions to either a community services through the the Ministry and HNZ
national, regional, or local leadership role. Ministry of Health four regional divisions
commissioning and operational functions will transfer to HNZ • Actively hosting and supporting Iwi-Māori
and MHA. This will evolve as we go through the co-design • Driving improvements in service Partnership Boards to influence priorities and
process and on the basis that a formal change process has delivery at all levels services in regions and localities
been initiated.
• Defining expectations for high- • Direct commissioning of mātauranga Māori
quality commissioning of services services, and co-commissioning health services
Accountability mechanisms
throughout the system, working in with HNZ
• The Government Policy Statement and the New Zealand partnership with the MHA
Health Plan will set the multi-year strategic direction for the • Leading a partnered inter-sectorial
system and form a key part of the new accountability settings. • Providing system-wide supporting commissioning approach to deliver whānau ora
The design of functions within HNZ and MHA will aim to Infrastructure and back-office through Māori health services
deliver the objectives laid out in these accountability functions
documents. These documents will replace the DHB Annual • Supporting the Ministry and the Budget process
Plans. The Ministry will monitor system performance, and will across the health system for Māori health
support the Minister of Health to use ministerial intervention outcomes
powers when required. The MHA also has a role in monitoring
Māori outcomes across the system in partnership with the • Leading the performance and accountability
Ministry. monitoring for the health system for hauora
Māori outcomes
HNZ MHA Operating Model and High level Structure | Update | 7
How will Health New Zealand and the Māori Health Authority work together?
Two organisations, one vision – Pae Ora
• The Waka Hourua is a
* developing metaphor
for the relationship
based on partnership
between Health NZ and
the Māori Health
Authority working
towards a common Pae
Tawhiti (Vision).

• This update sets out

how core functions –
Ngā Rā (the sails) – will
be established.

• Te Mauri o Rongo
(Charter) and alignment
of values will guide how
we engage with each
other and our
consumers, whānau
and communities.

• The Waka Hourua as

presented here is in its
early stages of
development and will
evolve as a framework
for engagement.

HNZ MHA Operating Model and High level Structure | Update | 8

 Nationally planned, regionally delivered and locally tailored
Our approach to organisation change and considerations of function shifts are based on the
2. From transition following principles:
to transformation: 1. Enable equity gains: Achieving equity for Māori and
populations or groups of people who experience
our approach to poor health outcomes happens by intentionally
designing equity into the way we do things, in
building our alignment with Te Tiriti. This requires national
planning to determine areas that need national
operating model consistency, coordination and possibly centralisation
to realise equity gains. Regional delivery will meet
national expectations while tailoring solutions to
address local needs and aspirations. We will remove
unwarranted variation in priority areas of inequity
and where we desire national consistency, while
enabling diversity of delivery models tailored to each
community’s local circumstances. This includes
tailoring for Māori in partnership with the MHA,
Pacific peoples, people living with disabilities (in
collaboration with the soon to be formed Ministry for
Disabled People), mental health and rural
communities where geographic access is challenging.
2. Simplify the way we organise ourselves to set us up
for transformation. We will bring together functions
that, through consistency and standardisation,
enable system efficiencies and the release of
resources to frontline care. We will plan services
nationally to ensure consistency of specification. We
will enable regions to oversee and lead delivery and
support the sharing of resources (people, funding,
time) to ensure that equity of access and outcomes is
improved for populations at a regional level. Local
tailoring of delivery models, however, will ensure we
are responsive to the diverse needs of local
communities within districts. Functions will have
clear accountabilities with a span of control that
allows focus, clear purpose and accountability for
their part of the system. Reporting lines for the
purposes of support, direction, feedback and
information flow will be simplified.
3. Unify our teams across geographic and professional
boundaries, so that our people can work together for
the benefit of patients, whānau and communities. By
simplifying funding models and support networks
where information and resources can be shared
across districts, regions and nationally, we can focus
on what is best for people. We recognise that the
sum of people’s experiences of healthcare is
delivered by ‘teams of teams’ or a range of
professionals that work together to contribute to
those experiences. Therefore, we are taking a whole
of system approach to how we work and build a
culture that leverages the reform opportunity to
work collaboratively. When this happens, each team
will have a clear focus on their role and can support
their members to do their best. More importantly,
however, teams can see where they fit in the overall
network of care and are able to build connections
with other parts, reaching out to strengthen their
relationships.
4. Engage the people who know best when redesigning
parts of the operating model so those functions are
positioned well for the future. We will not have all the
specific details on current ways of working, work
programmes, opportunities and risks of change
across the system. So we will establish working
groups to engage the experts in the system in both
design and implementation of change. The detail on
collective ways of working, work programmes,
opportunities and risks of change will be outputs of
this work. We will, however, invite external expertise
to work with us so that we open ourselves up to ways
of doing things that have been effective in other
health systems or adjacent sectors.
(continued on the next page)
HNZ MHA Operating Model and High level Structure | Update | 9
Our approach to change and operating model development
Our approach to organisation change and Phases of change
considerations of function shifts are based on
the following principles (continued) We are approaching change at a high level in the three key phases shown below. These phases
5. Structural change alone is not enough. The way are iterative in nature – various transformation activity is occurring in the transition phase.
we work together needs to change. We will need
mindset changes to make the shift from the DHB 1 Transition (to end of 2 FY22/23 Transformation 3 FY 23/24
environment to a collaborative national, regional, June 2022) through capability building Transformation
district and local networked way of working. The and quick wins and Delivery
New Zealand Health Charter (the Charter) will set the
expectations of the culture shift required from the • Prepare for implementation of • New leadership roles inherit • Established and
new system. The way we work together to get the new legislation. operating model stable leadership
best out of our clinical and managerial leaders to
• Creation of a unified implementation and structures.
share accountability for their teams and span
management structure, transformation programmes • Government’s health
geographical and professional boundaries will be
merging almost 30 entities including 3rd tier and system priorities
vital to the new operating model. Where existing
organisations or team values and ways of working including 20 DHBs, Ministry regional leadership roles, implemented or
align with the Charter, then we want to support that functions, 7 Shared Service district/locality functions. implementation has
being retained. We also need to work across the Agencies and Te Hiringa • Build function capability and been enabled.
system to support networks that span hospital, Hauora. processes to work across
specialist, primary and community care to work • Establish new leadership roles the system.
together. and set direction. • Identify opportunities for
• National and regional teams streamlining processes, for
6. We recognise substantial engagement has been
established in priority areas to example: forming regional
done to date on the Charter, with themes informing
receive transferring functions. hospital and specialist
its drafting. Further work through co-design with
• Working groups established to networks, clinical networks,
unions and stakeholders will take place. In the
meantime, the detail on how we will achieve the ‘sprint’ development of and nationalising ‘enabling’
alignment of values across organisations will be operating models e.g. Data & services such as Finance,
progressed. We will work with leaders and staff at all Digital being established, People & Culture, Pacific and
levels of the system to determine and support the Procurement & Supplies in Māori Health.
shifts needed in how we work together. progress.

HNZ MHA Operating Model and High level Structure | Update | 10

Our current focus is on transition
The key focus of this document is Phase 1 | Transition
A number of key activities are
happening in this phase, including:
• Implementation activities relating to the
merging of entities.
• Simplifying the way we make decisions.
• Unifying our people to work as a team
of teams to improve experience and
outcomes of care.
• Embedding how we partner with Māori
at all levels to improve equity and
outcomes through the Māori Health
Authority.
• Establishing Health New Zealand to
focus on achieving equity for Māori as
Tangata Whenua, and for groups who
experience poorer health outcomes.
• Building on existing relationships and
pathways to amplify the voice of
consumers and local communities in
how their health is delivered.
Reducing risks to business continuity
and disruption to the experience of
care for consumers, their whānau and
communities while we are changing is a
key priority.
A key mitigation is that, for the vast
majority of our teams, direct clinical and
managerial leaders - particularly in
hospitals and specialist networks,
reporting lines and functions - won’t
change from 1 July.
For the vast majority of providers currently
funded by the Ministry of Health and
District Health Boards, their direct
relationship manager will not change from
1 July 2022. Providers will receive
correspondence in due course notifying
them of the change in funder from
Ministry of Health/DHBs to HNZ or the
MHA. No other terms and conditions will
change unless mutually agreed.
By 30 June 2022, Health New Zealand
and the Māori Health Authority aim to:
• Agree the accountability settings for
both entities, including Ministerial
agreement to the Government Policy
Statement, New Zealand Health Plan
and other monitoring expectations that
will clarify the FY22/23 deliverables for
HNZ and MHA.
• Have either appointed or have acting
arrangements in place for 2nd tier
leadership and key 3rd tier regional
leadership roles to enable transfer of
roles and functions. Where acting roles
are in place, we aim to have recruitment
of permanent roles well progressed.
• Establish sector working groups to
develop the operating model and
complete plans for implementation.
• Complete the roadmap for the
proposed shifting of current functions
and reporting lines to the new
leadership structures, and engagement
with partners and the impacted parts of
the sector.
• Establish the main accountability and
authority delegations appropriate to the
next phase.
HNZ MHA Operating Model and High level Structure | Update | 11

3. Information on
Health New Zealand
Leadership
Functions
The purpose of this section is to:
• outline the functions that will form
the national leadership team of
HNZ, and some 3rd tier leadership
functions
• describe at a high level the roadmap
to determine more detailed
functions that engage our current
leaders
• outline the existing roles and
functions that will shift under those
leadership roles
• outline thinking around the existing
roles and functions that could shift
under those leadership roles
There will be a single tier ELT made up of three sub-teams
We will establish three teams that will make up the 2nd
tier national executive leadership of Health NZ:
The three teams comprise:
1. Clinical leadership who ensure executive decisions
are informed by technical and professional
expertise. This team will work with the MHA clinical
leadership. It includes but is not limited to:
• Medical
• Nursing and Midwifery
• Allied Health, Scientific and Technical
Professions
• Primary and Community Care
2. Delivery leadership who ensure all frontline care,
whether commissioned or provided by HNZ, meets
expectations of service coverage, quality and
improved experience. Some roles will have a
partner or co-lead in the MHA and some functions
will agree a joint work programme with the MHA to
ensure opportunities for Māori health gain are
embedded. This team includes but is not limited to:
• Commissioning
• Hospital and specialist services (including
Procurement and Supplies)
• National Public Health Service
• Pacific Health
• Service Innovation and improvement
3. Enabling leadership who will collaborate as
required with MHA executives (in some cases
establish a shared service level agreement). This
team includes but is not limited to:
• Finance
• People & Culture
• Data & Digital
• Health Infrastructure
A series of functions will be established as part of the
Office of the Chief Executive. Some of these functions
will be fixed term, as we implement the new
organisational structure and associated work
programmes. Functions that will sit within the Office
include:
• An executive from the MHA who will be
nominated by the MHA Chief Executive
• Change Management Office as a temporary
function to support Day 1 readiness and support
the transition process
• Ministerial and Government support
• Key compliance, accountability and sustainability
responsibilities
• Communications and Engagement
• Strategic advisor for Disability Support Services
• Taskforces where the CE requires a priority
focus and needs to draw on resources across
the system. At the time of writing, taskforces are
being established to oversee planned care,
tactical workforce development and
immunisations
Further detail on the single tier ELT can be found on the
following pages.
HNZ MHA Operating Model and High level Structure | Update | 12
A single tier ELT with three sub-teams

Health New Zealand

Chief Executive

Single Tier ELT

Clinical leadership team Delivery leadership team Enabling leadership team CE governance and change team

National National Director National Director National Chief Chief Executive Director Executive Director
National Director Chief People Chief Data MHA Change Governance,
National Director National Hospital & National Public Director Pacific Finance Infrastructure
National Commissioning and Culture and Digital Executive Management Partnerships &
Director Allied Health, Director Specialist Services Health Service Health Officer Investment
Director Office Risk
Nursing, Scientific & Primary and
Medical
Midwifery Technical Community National Director Executive Director Strategic Advisor,
Professions Service Task
Communication & Disability Support
Improvement & Forces
Engagement Services
Innovation

Executive
Director Chief Advisor,
Procurement & Sustainability
Supplies

Regional management board

Regional Directors Regional Regional MHA Enabling

Regional
Hospital & Specialist Public Health Pacific Regional functions
Commissioners
Services Service teams managers by agenda

District management board IMPB

Hospital & Local

District
Specialist MHA Pacific
managers
Services teams

HNZ MHA Operating Model and High level Structure | Update | 13


3.1 Clinical
leadership team
Clinical leadership* is critical to
assure ourselves that we are
supporting the provision of
quality and safe care and that
professions are enabled to do
their best. It also ensures the
voice of professions inform our
executive decisions from a
quality and safety perspective.
Matters for consultation
We will seek advice from this group on
how we embed clinical leadership into
our system that is fit for the New
Zealand context, drawing on published
learnings and experience in other
jurisdictions. The concept of a ‘Dyad’ or
dual accountability approach between
lead clinicians and managers across the
hospital network is of interest. From 1
July, working with the Chairs of existing
forums, we will develop a white paper
on what a dyadic clinical and
management leadership model could
look like and how it could be embedded
at all levels across our services.
*Clinicians, in this context can mean any
regulated professional.
Decisions that have been made
Clinical leaders will chair their respective national
forums. This team will comprise National Directors who
This team will be tasked with forming a professionally-
led, collective approach to the national implementation
lead but will not have direct line management of their
regional counterparts.
of workforce and model of care changes, while
modelling multi-disciplinary working. This team will
work with the Chief People & Culture to align with wider
workforce development.
HNZ CE This group has the following priorities:
• Initiate work on what quality and safety activities,
Single Tier ELT
reporting and intervention frameworks should be in
place nationally. For example, a national serious and
Clinical leadership team
sentinel event and clinical risk reporting system that
provides visibility on quality and safety incidents at
National
National
National Director National all levels, as well as follow up actions across the
Director
Director
Nursing,
Allied Health,
Scientific &
Director
Primary and
networks. This work will joint venture with the MHA
Medical
Midwifery Technical Community Clinical leads to ensure this activity can identify
Professions
outcomes trends for Māori.
It is intended that clinical leaders will report through to • Work with the National Director Hospital & Specialist
their local Hospital & Specialist leadership when they Services and National Commissioner to establish
are established. The National Director Primary and strategic clinical networks on national health
Community will work with the primary and community priorities. Networks will support clinical input into
sector to establish an appropriate clinical governance implementation of national priorities, service
and workforce leadership team in partnership with planning and delivery in hospitals & specialist
providers. networks with input from consumer engagement.
This team will work across HNZ and the MHA to ensure Networks will also be established to reflect the
alignment of national, regional and local workforce priorities of clinical leaders in the sector.
development activity for their respective professions
and ensure the growth of a diverse workforce with • Work with the Data and Digital leads to prioritise
particular focus on Māori, Pacific and people with systems that need to be established/developed early
disabilities. to enable quality and safety to be visible nationally,
The role of clinical leaders in the HNZ context is to chair regionally and locally.
and lead their respective national operational clinical To minimise disruption to clinical leadership, we will
leadership groups (e.g. National CMO Group, National work with existing Chairs of those national groups in
Director of Nursing Group); drive workforce innovations their current form to determine the functions and
and professional engagement in model of care subsequent leadership roles to be appointed from July.
changes; provide assurance of systems to enable This will ensure minimum disruption to national
clinical and professional competency in practice; and coordination and collaboration activity focused on
advise and intervene on clinical risks at a service level. building the resilience of the system during winter
2022.
HNZ MHA Operating Model and High level Structure | Update | 14

3.2 Delivery
leadership team
In our delivery system, we want
to:
• Enable the spread and
diffusion of improvements,
innovations and
transformations across the
Hospital & Specialist
system
• Reduce unwarranted
variation in care and focus on
equity improvement
• Support the diversity of
delivery models in regions
and tailored to local
communities
The structure of these functions
implements Cabinet’s decisions
for regional and local
leadership.
Decisions that have been made
This group of leaders are responsible for operational
delivery in the system. Delivery of care is either provided
New national and regional functions will be established.
Existing local teams will be shifted to report to these
by HNZ through Hospital and Specialist networks or
commissioned/funded and provided by other community-
structures.
The functions and current reporting lines that will shift
based services and 3rd party providers. when leadership teams are established are:
National Director - Commissioning
Health New Zealand • National Commissioner will be responsible for the New
CE Zealand Health Plan, national service planning and
Single Tier ELT
development, funding and standards which enable the
contracting, procuring and monitoring of services in
Delivery leadership team alignment with our health and equity priorities. The
National Commissioner will establish four Regional
National Director
National Director
National Director National National Director,
Commissioners who ensure the regional delivery of
National Public Director Pacific Service Improvement &
Services
Commissioning
Health Service Health Innovation services aligned to national expectations while tailoring
for local delivery. The National Commissioner will
ensure regions are responsive to consumer voices and
community engagement and enable regional clinical
networks to support hospital & specialist care.
Executive
Director
Procurement & • The National Commissioner will establish national
Supplies functions to enable improved commissioning and
support of localities at the regional and district levels
Regional management board
e.g. population health needs analysis, health
Regional Directors Regional Regional MHA intelligence and analytics, expertise on provider sectors
Enabling
Regional
Hospital & Specialist
Commissioners
Public Health Pacific Regional functions and negotiation of national contracts.
Services Service teams managers by agenda
• It is intended that the Ministry of Health commissioning
teams and SSAs that have service planning, funding and
District management board IMPB representative
support commissioning (e.g. Northern Regional Alliance
Hospital & Local and Technical Advisory Services) will be directed by this
Specialist District
Network managers
Pacific MHA role.
teams
Leaders
• The National Commissioner will establish district
managers and locality leaders to support tailoring of
For the purposes of this function, Hospital & Specialist implementation to local communities. Initial thinking is
networks include the community health services that the current DHB Planning & Funding teams and
provided by staff employed by DHBs (e.g. district related functions will report to District Managers from 1
nursing, community mental health). July or on appointment of a National Commissioner.
HNZ MHA Operating Model and High level Structure | Update | 15
Key roles within the Delivery leadership team continued
Continued role and scope for the commissioning function
• A working group, led by the National Commissioner,
will be established to determine detail regarding
national/regional/local functions, the operating
model for funding and how we will transition existing
roles and functions into the business unit. It is
envisaged that this will be established by 30
September 2022.
• Within the national commissioning office, national
leadership teams will be established in the following
service areas to implement the Government’s
objectives and national policy, and working in joint
venture or co-commissioning with the MHA, including
but not limited to:
• Primary and community-based care to include
general practice teams, pharmacy,
community-based referred services
including diagnostics and NGOs.
• Mental health & addictions, in partnership
with the Māori Health Authority to
commission across the continuum of care –
including from preventative services to acute
community-based services.
• Māmā, Pēpi, Tamariki (Child, youth and
maternity) to cover all services that impact
on the First 2000 days of life of children and
health and wellbeing of māmā.
• Health of older people services provided for
and impacting on older people to support
ageing well in communities.
• Acute Care whole-of-system approach to
ensuring capacity and coordination of acute
care across hospital and community settings.
This includes NASO and national networks
such as the Trauma Network.
• Adolescent and Young Adults health whole-of-
system view of the care that young people
receive and experience throughout the
system. HNZ will establish a focused team
that involves the participation of young
people in the design and delivery of their
healthcare.
• Ambulatory and Planned Care whole-of-
system approach to supporting the growth
and expansion of care provided in
ambulatory or community settings (including
specialist and diagnostic care) that can
reduce acute demand growth. It will also
look to expand care that can be provided
from acute to primary and community
settings.
• Long Term Conditions whole-of-system
approach to the integration of care provided
to people who live with long term conditions
– including cancer care – that aims to slow
disease progression and improve wellbeing
of people living with long term conditions in
communities.
Regional working
We will retain the same four regions – known as
Northern, Te Manawa Taki, Central and Southern – as
organising networks for the health system, but patient
flows that make sense to those communities will be
enabled.
We note that the Māori Health Authority and iwi may see
regional boundaries differently and the HNZ networks
will work to support iwi-determined regions. We will
support flow of care for Māori where their regional
boundaries may differ to meet the needs of iwi.
Regional Commissioners will be established in
geographic areas to ensure translation of national
settings and the performance management/oversight of
provision. Regional commissioners will ensure enabling
functions are providing appropriate business partnering
to support regional and local service delivery. They will
also ensure tailoring to regional and local communities
and support relationships and engagement with local
networks and localities. Regional commissioners will
work with their regional MHA counterparts and Iwi-
Māori Partnership Boards to ensure responsiveness to
Māori.
Districts in the reformed system
In this transition period, “Districts” refer to the 20
geographic coverage areas of the current DHB system.
Within a district, there may be a number of localities.
Some districts may see themselves more as a localities.
Over time, localities will take precedent and by July 2024,
every New Zealander will belong to a locality. Localities
will not be constrained by current district geographic
boundaries and will make sense to the communities
within them.
District Managers will be determined as part of
ongoing operating model development. District
managers will work within their regional contexts to
ensure national settings are applied consistently and,
where appropriate, tailored for local populations.
District managers will partner with their MHA
counterparts to agree areas for co-commissioning,
coordinate and support Māori providers while aligning
to Iwi-Māori Partnership Board settings and priorities.
Local teams will continue to be based in districts to work
with Iwi-Māori Partnership Boards, implement and
support locality development, ensure integration with
local hospital and specialist networks, and support
relationships and commissioning with local providers.
HNZ MHA Operating Model and High level Structure | Update | 16
Key roles within the Delivery leadership team continued
Scope and roles within the Hospital and Specialist Services function
National Director - Hospital and Specialist Services
• Will be responsible for operational delivery and
people leadership, and accountable for
performance of care provided by public health
hospital networks across the country. All hospital &
specialist services provided in publicly-funded
hospitals or what is known as ‘Provider Arms’
should report to this role nationally. This function
includes the provision of community-based care
provided by employed staff e.g. District nursing and
community mental health.
• Regional Directors, Hospital & Specialist
Services: The National Director will establish four
Regional Directors to support this wide span of
control. We will work with the regional
configuration in place today. These regional
boundaries, however, will not constrain consumers
moving to other regions where it makes sense for
them. Regional Directors will be supported to
establish health intelligence and analytics, regional
clinical networks and other capability to support
coordination of activity across hospital and
specialist networks. Regional Directors will be
supported by business partnering functions from
the Enabling leadership team to support
operational management.
• The reporting lines for all Provider Arms and their
staff should report to this role through their local
hospital leadership team and regional directors.
The National Director will work with the Clinical
leadership team to establish a national clinical
governance function to ensure quality and safety.
The National/Regional Directors will establish
leadership teams, which may be interim, for local
hospital and specialist services networks.
• Regional Directors will work within their regions to
establish regional clinical networks, work with the
National Director to support hospital & specialist
service development, monitor regional access and
equity of outcomes, and work with their Regional
Commissioner counterparts to ensure integration
across primary and secondary care is enabled.
Regional functions will be established to support
information sharing, service planning and sharing
of workforce resources, and enable workforce
development by coordinating training within each
region.
• Inter District Flows will not be a feature of our
system from 1 July because funding will be
allocated based on activity, capacity, and strategic
or new initiatives. An alternative process for making
costs transparent and visible to all leaders in the
network will be established. Regional Directors will
establish teams to support the oversight of
production planning and capacity management.
The enabling functions to support Regional
Directors will be confirmed as part of transition.
• While regions are organising constructs, they
should not constrain options for local hospitals and
networks who may wish to access care elsewhere
where there is capacity and better for consumer
access (e.g. Taranaki receives care from both
Waikato and Midcentral hospitals; similarly, Nelson-
Marlborough works closely with the Southern
region and Capital & Coast District). This role will
enable MHA engagement regionally and Iwi-Māori
Partnership Board influence.
Each district will establish a hospital leadership
team. Each hospital and specialist network will
retain their local clinical leaders – Chief Medical
Officer, Director of Nursing and/or Director of
Midwifery, and Director of Allied Health Technical
and Scientific Professions.
• We will establish transition workshops in each
region to invite clinical, consumer, iwi partners and
management leadership to work with us to refine
the functions that will be concentrated at a regional
level and how to best support local
hospital/specialist networks. These workshops will
be scheduled for June/July 2022.
• Executive Director - Procurement and Supplies
will report to the National Director, Hospital &
Specialist Services to ensure that the national
systems for procurement and supply have the
appropriate clinical engagement and monitor
performance against expectations for hospital and
specialist networks who are the client of this
function. A lead DHB Chief Executive will oversee
this in the interim. This role will advance the
implementation of Health Finance Procurement
and Information Management (FPIM) to cover all
districts. The Chief Finance Officer will also have a
role in the oversight of this national shared service
to ensure that the benefit of standardisation and
improved coordination of effort is achieved in the
hospital & specialist services networks.
HNZ MHA Operating Model and High level Structure | Update | 17
Key roles within the Delivery leadership team continued
Public Health, Pacific Health and Service
Improvement and Innovation
National Director - National Public Health Service
• This role will be appointed to implement the
operating model currently being developed by the
national public health network. A Joint Officials
group is establishing an operating model that
integrates 12 Public Health Units currently in DHBs
and Te Hiringa Hauora, along with screening and
population health functions and COVID-19
functions from the Ministry of Health. This service
will have joint management oversight with the
MHA. The work undertaken in this process is well
advanced and will confirm a structure based on
workshops and development with the public
health leadership community across the country.
Further detail will be made public in May.
• This structure assumes an MHA counterpart who
will work with the National Director - National
Public Health Service. This business unit will also
establish 4 regional directors and 3rd tier roles
that incorporate public health protection,
promotion, screening and immunisation and
prevention services.
National Director - Pacific Health
• This role will be established and appointed to be
responsible for Pacific commissioning, workforce
development and provider development, and
ensure localities are effective for Pacific
populations. It is the intention that all Pacific
functions within DHBs (both provider arm and
commissioning teams) will report to the National
Director Pacific Health but remain locally based.
• The National Director may establish regional • The National Director for Service Improvement
functions where there is critical mass of Pacific and Innovation will strengthen national Consumer
populations. The establishment of this business Networks to ensure that improvement is led by
unit ensures that funding flows directly to Pacific the voice of consumers. This role and their teams
providers and communities and delivery is will establish national collaboratives, projects and
responsive. initiatives across both hospital/specialist and
primary/community networks of care.
National Director - Service Improvement and
Innovation • This business unit will be the catalyst for improving
equity of access by identifying unwarranted
• The purpose of this role is to lead service and variations in care, and establishing programmes to
model of care changes in our system. The role will improve and leverage performance intervention
achieve this by identifying, in partnership with the levers at both hospital and locality level where
MHA, areas of unwarranted variation that should progress is slow. The scope of what can be achieved
be targeted through national programmes of through joining up networks or shifting reporting
action to reduce poor outcomes and improve lines is due to be scoped.
equity and quality of care. It will also establish a
platform and processes to enable diffusion and
spread of improvement, joint ventures to diffuse
proven innovations and support research and
evaluation in our operational context.
• The role may also include health analytics
functions that support a data-driven approach to
performance management and internal
monitoring. The group will advance shared
analytics and business intelligence tools that
enable all hospitals and specialist networks,
regions and localities to share their performance
data and catalyse opportunities for improvement.
A national working group will be established to
determine the operating model for health
intelligence and analytics.
HNZ MHA Operating Model and High level Structure | Update | 18

3.3 Enabling
leadership team
The role of the ‘Enabling’ leadership
teams is to ensure that frontline
delivery services (hospital and specialist
services and primary and community
care) have the necessary resources to
do their job well (e.g. information,
funding, capital infrastructure and
workforce).
There are four key enabling functions
that will support HNZ to deliver on the
ambition of the health reforms and
provide health services nationally,
regionally and locally. These functions
ensure we are meeting our budgetary
responsibilities, growing our workforce,
and building the infrastructure (both
physical and digital assets) for the
health system.
Enabling functions offer the greatest
opportunity for standardisation,
consistency and visibility in cost;
momentum to build capacity and
enable innovation through national
coordination; centralisation where it
helps maintain pace; and support for
rapid delivery and deployment of
resources.
Decisions that have been made
The agreed roles for this leadership team will have an
agreed Service Level Agreement in place with the Māori
Health Authority for support and sharing of functions. The
roles include:
Chief Finance Officer
• The Chief Finance Officer will be appointed to oversee
the structure and systems for national, regional and
district financial management functions. This role works
closely with the CFO of the MHA to ensure alignment of
financial reporting. The initial view is that all current DHB
finance functions and teams will report nationally to the
CFO. When appointed, the CFO will lead a national
working group with finance teams to confirm the
operating model that will ensure responsive business
partnership relationships and services are established
for regions and localities.
• The CFO will also have an oversight role over
Procurement and Supplies. While this function will report
to the National Director - Hospital and Specialist Services,
to ensure responsiveness to providers the CFO will aim
to ensure that national procurement and logistics realise
the value from nationalisation, and that standardisation
in the right places simplifies the way we work.
Chief People and Culture
• The Chief People and Culture will be appointed to be
responsible for ensuring HR business partnerships are
well embedded to support regional and local delivery. It
is envisaged that the current Human Resource and
People and Culture teams will report to this role. A
working group with the General Managers, Human
Resources in all the entities being merged will be
established to develop the operating model. This will
include what functions should be established nationally,
and the business partnering model to support regional
and local delivery.
• Full implementation of current national programmes e.g.
Holidays Act remediation, and work with employee
organisations to refresh our approach to bargaining (that
includes a wider engagement agenda for workforce
development, innovation, health, wellbeing and safety)
will continue to be supported. Payroll, Employment
Relations, Recruitment & Onboarding, Occupational
Health, Safety & Wellbeing and Learning & Development
will fall under this function. Some of these functions may
be regionalised with business partnering in place for
local or district based services.
Chief Data and Digital
• The focus of national work to date has been to ensure
Day 1 implementation of data and digital corporate
infrastructure is in place. The Data and Digital directorate
from the Ministry of Health, including Sector Operations,
has transferred to the HNZ business unit. A working
group has been established with an independent Chair
to engage all data and digital/IS and IT teams in the
entities being merged to develop the operating model
for this function. This includes determining what should
be led nationally and business partnering models that
will enable regional and local delivery. This group will
include all Chief Information Officers across DHBs and
SSAs. It will provide options on how best to organise
large and complex data and digital services to get the
best out of our talent, make visible the range of projects
underway to identify opportunities for shared learning,
and ensure the national priorities for system
improvements are achieved. It is important to get the
balance right on what should shift to a national level, be
regionalised and/or kept local in a way that does not
disrupt services and maintains momentum on major
capital investments in flight. This function is likely to
include digital strategy and investment, corporate ICT,
emerging health technologies and innovation functions,
plus functions and teams from SSAs.
HNZ MHA Operating Model and High level Structure | Update | 19
Key roles within the Enabling leadership team continued
Infrastructure Investment

Chief Health Infrastructure

• The Government is seeking a more proactive approach to

planning capital, more rapid delivery of projects that are
approved, and more transparent visibility of the benefits
that can be realised from those investments.

• The Chief Health Infrastructure will manage the

infrastructure investment capital pipeline and ensure the
execution and delivery of agreed capital projects. The
current Health Infrastructure Unit functions have been
transferred from the Ministry to HNZ. Health New Zealand
CE
• These functions will be strengthened and expanded, and
may be integrated with national and regional capacity Single Tier ELT
overseeing capital planning and project execution. This
function will be expanded and strengthened as part of the Enabling leadership team
implementation of changes once health capital settings are
agreed by Ministers. Its functions include health
infrastructure planning, capital investment advice and Chief Financial Chief People and Chief Data and Chief Infrastructure
programme/project delivery. The business unit will also Officer Culture Digital Investment
report benefits realisation from investments.

• A working group is to be established with an independent

Chair to engage all capital development, design and
execution teams to assess how national, regional and local
project delivery functions may best be organised. While
clinical engineering assets are critical parts of local delivery,
the scope of this working group will consider what the
opportunities for regional coordination or collaboration
may be that do not disrupt local business support for
clinical delivery.

HNZ MHA Operating Model and High level Structure | Update | 20


3.4 Office of the
Chief Executive:
Governance and
Change team
A series of functions will be
established as part of the Office
of the Chief Executive. Some of
these functions will be fixed
term, as we implement the new
organisational structure and
associated work programmes.
Functions that will sit within the
Office include Ministerial and
Government support, key
compliance and accountability
responsibilities such as the
corporate secretariat, legal, risk
management and privacy.
Decisions that have been made
Key roles within this team include:
Māori Health Authority Executive
• This role will be a nominee from the MHA Chief
Executive. They will embed Māori strategic leadership
and strong partnership across both organisations. They
will work alongside the other mechanisms present to
strengthen Māori presence and decision making at all
levels of the system.
Executive Director - Change Management Office
• This will be a temporary function to meet our assurance
requirements for Day 1 readiness and support the
transition process. A Change Management Director will
be appointed until 30 June 2023 to manage the transition
of all functions. This includes the merger of SSAs.
Executive Director - Governance, Partnerships and Risk
• This role will be appointed to ensure HNZ is able to meet
its Parliamentary and Cabinet responsibilities and
accountabilities, including transparency requirements
such as proactive release policies and OIAs, to support
Ministers and Ministers’ offices with briefings,
parliamentary questions and Select Committees. This
team will include Board Secretariat, Chief Legal Counsel,
cross-government stakeholder management, and an
advice function to support work with relevant policy and
regulatory agencies on the operationalisation of policies
and regulations that impact HNZ, including briefing the
Board and Minister as appropriate.
• This team will be responsible for risk management,
internal audit, and supporting HNZ to meet Treasury,
Ministry of Health and Board monitoring requirements.
This will include tracking HNZ progress against the New
Zealand Health Plan from a whole of system perspective.
• A Chief Advisor, Sustainability will be appointed as
part of this team to advise on how HNZ will achieve the
Government’s sustainability goals in the health system.
Executive Director - Communication and Engagement
• This role will be appointed and agree an action plan for
change communication and engagement. Further work
will be done on how to organise national and regional
teams for media, communication and engagement with
the national group of DHB Communications GMs. We
envisage an organisation-wide function that champions
trust and confidence in both HNZ and MHA – and the
health system more generally. This role will establish the
channels that promote transparency across the network.
• Community voice: To support this, the Communication
and Engagement function will also look to design a
communication system that ensures communities and
stakeholders are heard, that those communities
influence the work and priorities of MHA and HNZ, that
effective communication channels are in place to ‘close
the loop’ to ensure health consumer needs are met, and
the public is informed about the work (‘tell the story’) of
the two organisations. Where local districts have
community forums or councils, those groups will be able
to feed directly into the CEO through this role.
• Community Trusts: The Communication and
Engagement function may also be the point of contact
for the more than 50 community and philanthropic
trusts that support their local communities’ wellbeing. It
is the intention of HNZ to continue to support the local
responsiveness of those trusts and support their direct
relationship with local hospitals and providers.
Strategic Advisor - Disability Support Services
Additionally, an advisor on Disability Support Services will
be established to advise the Chief Executive on how the
organisation and its services can be more responsive to
people with disabilities. This may include supporting the
successful implementation of the new Ministry for Disabled
People.
HNZ MHA Operating Model and High level Structure | Update | 21
Roles within the Office of the Chief Executive continued
Taskforces
Where there are urgent pressures that cannot
wait for leadership functions to be established,
the CE and the Board will appoint taskforces to
make rapid progress on issues. The taskforces
may act with the mandate and authority of the
CE and the Board to direct and task activity.
There are three fixed-term task forces that are
in the process of being established in the short
term, while the 2nd tier leadership roles are
being appointed.
These taskforces are:
1. The Planned Care taskforce will centrally
coordinate commissioning and engage with
clinicians on prioritisation of activity for
planned care delivery over the next 12-24
months. This Taskforce will be chaired by
an experienced senior leader, to support
the taskforce and work with the sector to
make sure implementation is consistent
across the country. This includes working
with private hospital capacity in a more
coordinated way, with subspecialty groups
to advise on prioritisation and primary and
community provider networks to add
capacity to specialist assessment pathways.
This Taskforce will be established until
national and regional roles and functions
are in place to take responsibility and
accountability for delivery.
2. The Workforce taskforce, with a National
Lead, will agree the key priority
interventions for immediate workforce
expansions where service failure is at risk if
the workforce is not supported in the short
term. This Taskforce will work with Health New Zealand CE
employee organisations, relevant union
partners, tertiary training institutions and
professional regulators to accelerate the
need for trained workforce in priority CE governance and change team
service areas while national strategic
workforce initiatives are being
implemented. Executive Director Executive Director
MHA
Change Governance,
Executive
3. The Immunisation taskforce aims to Management Office Partnerships & Risk
increase the uptake of seasonal flu and
childhood immunisations. This will provide
added protection to the system during Executive Director Strategic Advisor
Task
winter. This Taskforce aims to work with Communication & Disability Support
Forces
existing ways of working established by the Engagement Services
COVID-19 response, sustaining and
continuing those models effective for
COVID-19 vaccination to increase influenza, Chief Advisor
childhood immunisations and MMR vaccine
Sustainability
uptake among young people. This includes
community-based provider models that
have reached out to Maori, Pacific, rural
and other population groups.
HNZ MHA Operating Model and High level Structure | Update | 22
The Māori Health Authority’s
organisational structure

HNZ MHA Operating Model and High level Structure | Update | 23

4. Māori Health
Authority
An effective health system for Māori
and all New Zealanders requires the
MHA to provide system leadership
and direction, ensuring the system
delivers high quality and equitable
outcomes. To ensure this occurs,
the MHA has a broad strategic remit
to ensure the health system works
well for Māori and all groups.
Information about the Māori Health Authority
The Māori Health Authority is responsible for:
• leading change in the way the entire health system understands and responds to Māori health needs
• developing strategy and policy which will drive better health outcomes for Māori, including advice to Ministers
• commissioning kaupapa Māori services and other services targeting Māori communities
• co-commissioning other services alongside HNZ
• monitoring the overall performance of the system to reduce health inequities for Māori.
Partnership with Māori and the integration of Māori voices into health planning and priorities will be an essential
feature of the new system. Partnership and engagement with Pacific people, other communities and consumers of
Health services in governance, prioritisation, planning and commissioning will also be essential to achieve equity of
outcomes.
The Māori Health Authority cannot achieve this on its own
• The MHA will have a co-leadership role, jointly leading and agreeing with HNZ the national planning and key
operating mechanisms that the system will use.
• The system needs to ensure that hauora Māori and Māori Health equity are front and centre in operations
across our system – from the Ministry to hospitals, and across localities, kaupapa Māori providers, iwi and Māori
providers and Māori communities. To do so, there is a clear requirement that outcomes and expectations for
Māori health gains are set nationally and embedded into the objectives and accountabilities of HNZ, so that all
Health services are designed and delivered in support of equity and in line with our Te Tiriti o Waitangi
obligations.
• Iwi-Māori Partnership Boards (IMPBs) are a key feature of the reformed system. IMPBs will have decision-
making roles at a local level, and jointly agree local priorities and delivery with Health New Zealand. They will
also be the primary source of whānau voice in the system and be able to influence regional strategies through
the MHA.
• From 1 July all Māori health functions within entities will transition to HNZ as part of its establishment. A
working group will be established as a joint venture between MHA and HNZ to develop the operating model for
MHA that may include the shifting of certain Māori health functions from HNZ to MHA. This will provide capacity
for MHA to support commissioning and Māori health providers, and progress the establishment of delivery
models that are responsive to Māori health needs. This group will be led by the MHA senior executives in joint
leadership with HNZ.
HNZ MHA Operating Model and High level Structure | Update | 24
The proposed future organisational structure for the Māori Health Authority
• The MHA’s proposed future organisational structure has been designed along functional lines and the
Our 16-point wind compass five core functional building blocks. It has been organised into six proposed directorates, depicted by
a sixteen-point wind compass.

• The organisational structure supports the analogy of a waka hourua on a journey to Pae Tawhiti using
the traditional compass to help navigate. The design of the MHA on the traditional compass provides
clear direction and purpose.
a. Whakairo: The first/outer porowhita depicts our people and is
illustrated through the notches that our carvers make when developing
our whakairo. This represents our Te Aka Tari/Tahua (Corporate
Services) including finance, people and capability, our organisational
(internal) facing strategy and performance management, and our shared
services agreement with HNZ for back-office function delivery.

b. Manu, Mangopare: This porowhita depicts the manu and mako that
were often tohu on our journeys. They provided insight and
confirmation that our destination was near. This represents two key
groups:

i. Te Aka Mātauranga (Mātauranga Māori) is about a Māori way

of being and engaging in the world. In its simplest form, it uses
kawa (cultural practices) and tikanga (cultural principles) to
critique, examine, analyse and understand the world. It is based
on ancient values of the spiritual realm of Te Ao Mārama (the
cosmic family of the natural world) and it is constantly evolving
as Māori continue to make sense of their human existence
within the world. The purpose of this group is to provide internal
support to staff and the board with Mātauranga Māori, including
tikanga and te reo coordination, supporting external
communications, and providing leadership and direction to
support MHA in the pursuit of its vision and objectives.

ii. Te Aka Tōakiaki (Governance and Advisory), led by a DCE who

will also be our Chief of Staff, exists to provide direct support to
the Chief Executive and provide advisory, ministerial and
executive services for the wider organisation. This group will be
responsible for Board governance, organisational governance,
ministerial services, communications and engagement and
house the office of the Chief Executive.

HNZ MHA Operating Model and High level Structure | Update | 25

The proposed future organisational structure for the Māori Health Authority
iii. Te Aka Tau Piringa (Service
Our 16-point wind compass Development and Relations) will
span a range of delivery areas.
Haehae Pākiti: This porowhita depicts our Focus will be to design and invest
fences and/or the pā tū that surround our in health services that work for
kāinga. It also demonstrates direction and Māori by ensuring strong iwi
how we constantly move to address the partnerships, developing a
needs of our organisation and journey. This thriving Māori workforce, and
concept is applied to our three organisational funding Te Ao services. As such,
delivery groups: this group will be responsible for
the commissioning (co-
i. Te Aka Whakamua (System Strategy commissioning, direct
and Transformation) will align the commissioning and partnered
different components of the Health commissioning) of Te Ao Māori
Sector and broader system around a set solutions, developing the Māori
of shared objectives and priorities to provider workforce, and
achieve MHA’s vision, and to encourage establishing, supporting and
and enable delivery against them. They maintaining Iwi-Māori Partnership
will lead strategy for hauora Māori, Boards. Specific service-related
deliver hauora Māori research, functions in this group will include
evaluation and innovation, partner with Primary and Community Care,
HNZ on national health planning and will Public Health, Oranga Hinengaro
monitor the performance of the health and Hospital and Specialist
system for equitable Māori health Services. This group will also
outcomes. include our regional relationship
managers to co-lead with HNZ.
ii. Te Aka Tukanga (System Policy) exists to
provide policy and strategic advice to the Pae Tawhiti/Pae ora: The final
Minister on matters relevant to Hauora porowhita addresses our destination
Māori (s.19(1)(h) Pae Ora Bill) to advance and in this illustration you can see
Oranga Whānau & achieve equity. They the elements of our maunga, moana,
will drive system change to ensure the awa and our wharenui/marae/
wider health system delivers for Māori, in waharoa. While this is not an
a way that works for Māori, and organisational function of the MHA, it
influence all of government outcomes for is our purpose and represents the
Māori beyond the Health Sector to create requirements that once we reach our
environments that support Māori to be destination, we must walk through
well and thrive. They will also lead the doors of our whare and realise
strategic and operational updates for the the desired outcomes.
Lead Minister.

HNZ MHA Operating Model and High level Structure | Update | 26

4.1 Māori Health
Authority further
design work in
progress
Over the coming months we will
continue to design our operating
environment, particularly our
commissioning and co-
commissioning responsibilities and
regional structures with HNZ.
Additional information on the Māori Health Authority’s commissioning responsibilities
The Māori Health Authority is continuing to work on the
design for its regional operations and commissioning
functions.
Regional working
• Regional managers / leadership will continue to
evolve to determine how they will work with their
regional counterparts at HNZ, including
commissioners to shape and form strategy, monitor
hospital delivery and operate cohesively as a region.
Commissioning
• MHA commissioning functions will directly fund and
direct the provision of kaupapa Māori services and
other services targeted at Māori communities,
whether directly and/or jointly with HNZ.
• The MHA will also lead on nationwide Māori
provider development and the expansion of
kaupapa Māori services, as well as having a strong
mandate to encourage and invest in innovation in
delivery of local services and new service models to
meet Māori Health needs.
• The MHA will have co-commissioning functions with
HNZ in those services that have a significant impact
on Māori Health outcomes. This includes, for
instance, primary health services, population health
screening and immunisation programmes. While
HNZ will lead on operational matters relating to
general health service commissioning, this
responsibility will clearly entail delivery of improved
health outcomes and equity for Māori. The MHA
would influence and agree these intended
outcomes, set services expectations and initiatives
to reduce bias, undertake monitoring, engage with
iwi/Māori and approve final plans and resource
allocation.
• To ensure the MHA is sufficiently empowered, for
instance if the services commissioned fail to deliver
intended outcomes for Māori or address inequity,
the MHA has an escalation pathway for resolution
that could ultimately reach the Minister.
Discharging the roles of a commissioner, co-
commissioning and strategic system monitor will
afford the MHA an unprecedented position with
relation to hauora Māori.
HNZ MHA Operating Model and High level Structure | Update | 27
The proposed future leadership structure for the Māori Health Authority

MHA Proposed organisation structure

• The MHA proposed organisation structure has been designed based on a 16-point wind compass to depict our anticipated work flow. While the standard
organisational diagram doesn’t feature in our design on purpose, we have provided one for shared understanding of the intended national leadership
form and function of the MHA.

MHA Board

TE AKA MATUA
Chief Executive
Senior Executive
Assistant

MAIAKA AKA MAIAKA TU PIRINGA

MAIAKA MAIAKA WHAKAMUA MAIAKA TAHUA MAIAKA HŌTAKA
TŌIAKIAKI MAIAKA TUKANGA DCE MAIAKA TARI
MĀTAURANGA DCE System Strategy & DCE, Chief Financial Programme Office
DCE Governance & DCE System Policy Service Development DCE Corporate Services
DCE Mātauranga Māori Transformation Officer (time limited group)
Advisory / Chief of Staff & Relations

HNZ MHA Operating Model and High level Structure | Update | 28

Interim Maori Health Authority
Our initial national organisation functional design

Board

TE AKA MATUA
Chief Executive

Senior
Executive
Assistant

MAIAKA TŌAKIAKI MAIAKA MAIAKA MAIAKA TAU MAIAKA TARI MAIAKA TAHUA MAIAKA HŌTAKA
DCE Governance & MĀTAURANGA WHAKAMUA -DCE, MAIAKA TUKANGA PIRINGA DCE,
System strategy & DCE, system policy Service development DCE, Corporate DCE, Chief finance Programme office
advisory/ chief of DCE, Mātauranga (time limited group)
staff transformation & relations services officer
māori

CE Advisory Group Strategy & Oranga People and

Whatukura Whānau Policy Finance
Chief Advisors Planning Hinengaro Capability
Chief Clinical
Advisors Public &
Monitoring and Organisation
Māreikura System Policy population Shared services
Pou tikanga Accountability Strategy &
health
Performance

Board Mātauranga Primary &

Outcomes
Secretariat Māori pure community care
Data and Digital

Mātauranga Hospital &

Ministerial and Māori te Ao Innovation and
Insights specialist
Executive hurihuri services
Services
Te Tiriti law / Commissioning
lore and Co-
Communications Commissioning
& Engagement
Whānau voice Workforce
development

Regions &
Relations

Note: We are continuing to work on the design of our regional and local structure in
partnership with Health New Zealand and will communicate this in due course
5. System shifts Health New Zealand and the Māori Health Authority will work together at multiple levels

and putting it
together
Health New Zealand Māori Health Authority
The Māori Health Authority also has HNZ Board MHA Board
Boards of the MHA and HNZ work closely
a role to monitor HNZ delivery in together on agreed joint subcommittees
partnership with the Ministry of
Health. HNZ Chief
Executive
TE AKA MATUA
Chief Executive
Chief Executives partner and align on key
functions and decisions impacting Māori
Senior
health gain, including ensuring
Executive organisation structures have clear
To achieve the desired impact on Assistant
pathways for partnership and ‘mirrored’
Māori in some areas, the MHA and roles across organisations
HNZ will have mechanisms for Single Tier ELT

working together at all levels of

both organisations. Clinical
Delivery leadership
Enabling
CE governance and
MAIAKA
WHAKAMUA
MAIAKA
MĀTAURANGA
MAIAKA
WHAKAMUA
MAIAKA
TUKANGA
MAIAKA TU
PIRINGA MAIAKA TARI MAIAKA TAHUA
MAIAKA HŌTAKA
Programme office
leadership leadership DCE Governance
DCE, Mātauranga
DCE, System
DCE, system
DCE, Service DCE, Corporate DCE, Chief finance
(time limited
team change team & advisory / chief strategy & development & services officer
team team of staff
Māori
transformation
policy
relations
group)

Some of these mechanisms are part

of the overarching system
accountability framework, such as
the Government Position Statement
and the New Zealand Health Plan.
• Some roles will have a partner in the MHA and some functions
• Delivery and Leadership Teams work jointly with
MHA counterparts will agree a joint work programme with the MHA to ensure
• MHA Executive role present in the Governance and opportunities for Māori health gain are embedded.
Change team to ensure alignment and partnership These include:
• The National Commissioner
• National Public Health Service
• Innovation and Improvement
• Roles within the regional management board

HNZ MHA Operating Model and High level Structure | Update | 30

Putting it into practice

Ministry of Health

Monitoring

GPS – Regional
Strategy Regulation

The Māori Health Authority Health New Zealand

Partnering Leadership
Office of CE Kawenata in draft Office of CE
Mātauranga Māori NZ Health Plan System Performance Management
System Strategy & Transformation Code of Consumer Participation Governance, Partnerships & Risk
Governance & Clinical Advisory* Engagement Communication & Engagement
System Policy* NZ Health Charter, Locality Plans Clinical Leadership

Delivery

Service Development & Co-Leadership National Director, Commissioning

Commissioning Relations Hospital & Specialist Services
Joint Venture
Co-Leader NPHS National Director, Service
Delegated Authority
Improvement & Innovation
Pacific
Key
National Public Health Service
Mechanisms for
Enabling working together
Chief Finance Officer Service Level Agreement Chief Financial Officer
MHA Functions
Corporate Services: People Culture, Capability Building People and Culture
IT, Infrastructure
Data and Digital HNZ Functions
Infrastructure Investment

*Works with MOH on monitoring

Health NZ Future Design Blueprint | Summary | Health NZ Blueprint Overview 31


5.2 Regional and
local level
functions
A number of assumptions were
made by Cabinet on the
regional and local level
functions of both Health New
Zealand and the Māori Health
Authority.
Ongoing operating model
development and organisation
design builds on these
assumptions to create
something fit for purpose and
that will deliver the
transformation promised by the
reforms.
Decisions that have been made by Cabinet relating to regional functionality
Assumptions around regional and local level
functions include:
• HNZ and the MHA will work together at a
regional level.
• HNZ will have four regional divisions.
Each of these divisions will have two
distinct arms:
1. Commissioning primary and
community services
2. Managing the delivery of health
services
• The HNZ regions will establish, within a
national framework, analytics, monitoring,
contract management and integration of
planning for primary, community and
hospital services.
• Each region will establish district offices
that are located closer to communities.
District offices will act as “population health
and wellbeing networks”. These District
Offices will also be supported by the
National Public Health Service regional
leads.
• The MHA will have regional teams, co-
located with HNZ and embedded in
regional management arrangements to
ensure partnership, with approval rights for
all relevant strategies and plans at the
regional and locality level.
• IMPBs will be able to voice the aspirations
and priorities of Māori communities, agree
locality plans and influence regionally
through their relationship with the MHA.
• Primary and community care will, over
time, serve communities through locality
networks. Every locality will have a
consistent range of core services, but how
these services are delivered will be based
on the needs and priorities of local
communities.
HNZ MHA Operating Model and High level Structure | Update | 32
How will regions work?
Regional integration through Regional Management Boards
Integration in the regions will be achieved by HNZ
and the MHA establishing a regional management
board that brings together the key regional
leadership functions. The Regional Board may be
chaired by the HNZ/MHA CE or a delegated Regional
Director. This is to be determined. Together, the
regional management board may undertake a
whole of regional population health needs analysis
to inform commissioning. We will undertake
regional workshops with clinical, service and
provider leadership to co-design how the region will
work together. Functions brought together through
this management board may include:
• Enabling Regional Leaders: business partner to
enable delivery, achieve national consistency and
spread of national guidance, provide capability
for intelligence and analytics to support service
planning and its delivery, support workforce
development and people leadership, be
responsible for delivery of major capital works*
in region.
• Regional Commissioners: within delegations,
commissioners fund regional and local provision
of services consistent with the NZ Health Plan
and service coverage expectations. They plan
services, monitor, and performance manage
variations in delivery. They commission private
regionalise workforce development (e.g. training,
clinical, education partnerships), identify
variations in equity of access (shared wait lists)
and deploy resources to address this, support
clinical networks input to regional clinical service
development, integrate capital planning for
hospitals aligned with service planning** and
lead execution of major capital works*. There is a
presence of business partner support from
enabling functions in this function.
• Regional Directors will work with National Clinical
Leaders to establish, lead and manage regional
clinical networks and their leadership in service
planning, performance monitoring and outcome
impacts, engage consumer views, establish MDTs
and ensure input to capital and service
developments.
• Māori Health Authority regional managers
work with their HNZ counterparts to translate
national Māori health priorities, support iwi
engagement at the regional level, form the direct
reporting line for local IMPB support teams and
input priority equity gain initiatives. They also
enable regional commissioning of Māori capacity
and capability.
• Regional Pacific teams will be determined by
• Regional Public Health Service will integrate
public and population health input to regional
decision making, service planning and integration
to ensure equity of outcomes in population
health programmes. They will also provide public
health protection and health promotion services
to the region, unifying public health units
regionally to support workforce growth, health
promotion and population health programmes in
localities.
• The region may have programmes of action that
drive the spread and diffusion of nationally-
prioritised improvement and innovation and
implement regionally-agreed initiatives across
the system i.e. prevention, primary and
community care, hospital/specialist, coordinate
regional consumer voice networks.
Chair
Regional management board
Enabling Regional Directors
functions by Hospital &
MHA Regional Regional
Managers Commissioners
agenda Specialist Services

hospital capacity and are the direct reporting line the relevant operating model working group. This
for Locality leadership, supporting relationships role may commission and locally deploy Regional
Regional
with primary and community providers and resources to Pacific providers and build their Public Health
Pacific teams
Service
leading regional service planning. capacity for service provision. Working with the
Regional Commissioner, they may commission
• Regional Directors Hospital & Specialist services and form the reporting line for local
Services: potentially serve as the direct reporting Pacific teams within hospitals and coordinate
line for local hospital and specialist service their workforce with the Hospital & Specialist
leaders. They establish a regional view of Services role.
production capacity and its deployment,
*Joint responsibility between Regional Leader and Regional Hospital & Specialist Services HNZ MHA Operating Model and High level Structure | Update | 33
** Led by the Regional Commissioner with input from Hospital & Specialist Services and community-based providers
District integration through locality networks
Interfaces with IMPBs, Districts, Hospitals and Localities
Integration will be facilitated with and through
district partners (in the interim, the current DHB
areas). This may be part of the role of regional
commissioners to chair and hold local
relationships.
Key relationships and partners include:
Enablers business partner with local leaders to
ensure resources are allocated appropriately and
local managers and clinical leaders are supported
through regional teams (i.e. HR). These regional
teams provide local intelligence and analytics to
support local/district planning and performance
management, capital planning, procurement and
logistics, and data and digital innovations.
Hospital & Specialist Network leaders manage,
lead and are accountable for hospital and specialist
network delivery including community-based
healthcare e.g. district nursing and services
provided in community hubs. They also support
regional clinical networks and service planning,
manage acute demand, input to capital planning to
support future growth and development, ensure
and assure quality and safety of delivery, work with
local commissioners and Māori partners to ensure
responsiveness, and work with primary and
community partners to support service integration,
flow, and equity initiatives.
District Managers, under delegation of Regional
Commissioners, manage local funding, work with
and engage local provider networks and partners,
support Locality networks including engagement
and use of consumer voices in locality plans,
integrate with hospital and specialist services, pool
budgets and hold funding to support local
initiatives.
Iwi-Māori Partnership Boards do not formally
come into effect until 1 July 2022; however, as
tangata whenua they are expected to partner in
planning around health priorities and services at Chair, Iwi-Māori Partnership
the Locality level within their rohe or coverage area; Commissioner Boards
ensure the voices of whānau Māori are made
visible within the health system; and embed
mātauranga Māori within locality plans, which then
District integration functions
influence and inform regional and national
planning. Hospital &
Specialist District
Pacific team MHA
Network Managers
Pacific teams, where appropriate (i.e. dependent leaders
on population size and scale), work with local
partners to support provider networks and Pacific
access to services, and engage Pacific communities
and consumers.
Consumer-led Innovation and Improvement
support execution of national improvement and
innovation priorities e.g. population health
programmes, system flow initiatives such as acute
demand, ambulatory care access, and support and
enable whole-of-system engagement at the local
level of consumer.
HNZ MHA Operating Model and High level Structure | Update | 34
6. Next steps
1. “Sprints” to develop
operating models will be
established.
2. Recruitment for 2nd tier
roles will commence.
Change Management
The Change Management Office is being established to
work to the CEs of both HNZ and MHA. The CMO will
oversee a portfolio of workstreams where each
function will establish a working group to develop the
next layer of detailed operating model, including
functions that will be established nationally, regionally
and locally, and an implementation plan.
Working groups will have independent Chairs and will
include members from outside the health system to
provide us with challenge and fresh perspectives.
Working groups will be asked to ‘sprint’ or dedicate
concentrated time to develop these models within 12
weeks or 3 months. Those workstreams are attached as
Appendix 2. This is not a complete list and more may
be added as the operating model needs of HNZ and
MHA evolve.
The membership and contribution to working groups
will be coordinated through national groups that bring
together current DHB leaders and outside thinking for
fresh perspectives. Some groups have been established
e.g. Procurement and Supplies (working with Shared
Services), and Data & Digital (working with CIOs in DHBs
and Shared Services) and Hospital & Specialist Services.
Remaining workstreams are in the process of being
populated and established. We will publish regular
updates and communications on how those groups are
progressing on our website.
Channels for feedback, frequently asked questions and
answers will be put in place to enable all interested
groups to participate and offer advice. The interim
websites are in place as a regular place for updates to
be provided: mha.govt.nz and hnz.govt.nz
Selection and appointment process
Recruitment for 2nd tier leadership roles will
commence immediately. The key leadership attributes
we are seeking from those leaders are:
• The ability to work collaboratively as a Te Tiriti
partner on behalf of the Crown, aligned with the
values outlined in the Charter, and to proactively
lead on initiatives and improvements that enable
actions on equity;
• To be a whole-of-systems thinker, who can deliver
and work across boundaries to break silos, and make
collaboration across functional and geographical
boundaries the easy and right thing to do;
• Able to engage people and support their leadership
teams to work in partnership with their workforces
and representatives to improve how we work and
spread proven innovations effectively; and
• To value diversity of thought and experience in their
teams with particular emphasis on services, users
(consumers) and local/community-based
experiences.
Mana and Kerridge & Partners have been engaged to
deliver an external lens to the recruitment process. All
roles will be contestable and advertised publicly.
HNZ MHA Operating Model and High level Structure | Update | 35
Appendix A |
Workstreams
draft
A number of workstreams
have been identified where
further thinking and
engagement must occur to
progress operating model
development.
Some streams have already
been or are about to be
established to begin their
’12-week sprint’.
Summary of workstreams for ongoing operating model development
Leadership Function
Māori Health Leadership and
establishment of functions in the
Māori Health Authority
National and Regional Clinical
Leadership
Delivery Leadership
Enabling Leadership
Integration
Workstream
Māori Health capacity and capability (to be established with Tumu Whakarae)
Clinical Leadership and Governance, Clinical Network Establishment, National Quality
& Safety System establishment
Hospital & Specialist (advisory group in place to be formalised as a working group)
Commissioning (to be established)
National Public Health Service (established and in progress)
Service Improvement and Innovation (to be established)
Pacific Health (to be established)
System intelligence and analytics (to be established)
Procurement & Supplies (established and in progress)
Finance (to be established)
People & Culture (to be established)
Data & Digital (established and in progress)
Health Infrastructure (established and in progress)
Corporate Services – Sector Facing (audit and compliance, risk – to be established)
Regional and District functions (to be established)
HNZ MHA Operating Model and High level Structure | Update | 36
Appendix B |
Summary of
functions transfer
to HNZ
The aim is that most
functions will transfer to
the interim agencies in
advance of 1 July 2022,
which will help set up
the new agencies for
success. Functions already transferred from the Ministry of Health to iHNZ and iMHA
Shared Service Agencies (SSAs) coming into HNZ
• NZ Health Partnerships Limited
• Central Region’s Technical Advisory Services Limited (TAS)
• Health Alliance NZ Limited
• Health Source
• Northern Regional Alliance
• HealthShare Limited
• South Island Shared Service Agency Limited
We note that under the legislation Te Hiringa Hauora (HPA) will be disestablished and assumed by Health New
Zealand. Some roles from Te Hiringa Hauora will transfer to the Public Health Agency (i.e. those working on the
alcohol and advice functions).
Many individual DHBs also own or have joint ventures in organisations specific to their local needs. Ownership of
these entities will transfer to HNZ as part of the transfers of DHB assets.
Teams within the following Ministry of Health functions have already transferred to iHNZ
• DHB Performance and Support
• Health Workforce
• Pacific Health
• System Strategy & Policy
• Data & Digital
• Infrastructure
In addition, the Māori Health Team Service Improvement (commissioning) team has transferred from MoH to iMHA.
HNZ MHA Operating Model and High level Structure | Update | 37
Appendix B |
Summary of • There will be further functions transferring from 1 June, but for now the immediate focus is on 1 May.
functions transfer • The following table shows the directorates and business groups or teams from which positions (around 325)
to HNZ • Please note: this does not mean that all positions within those busines groups are transferring. Everyone in
The aim is that most
functions will transfer to
the interim agencies in
advance of 1 July 2022,
which will help set up
the new agencies for
success.
Phase 2: Upcoming Function Transfers from Ministry of Health to iHNZ
will be transferring to the interim entities from 1 May 2022.
a position that is transferring will have already been advised.
Directorate Positions transferring from these business groups
Health System • Primary Health Care System Improvement and Innovation
Innovation and • Community Health System Improvement and Innovation
Improvement
• Child and Community Health
• Clinicians Screening
Population Health and • National Screening Unit
Prevention • Population Health Programmes
• Public Health
• Office of the Deputy Director General
Infrastructure • Investment Strategy (timing to be confirmed)
• Health Workforce Commissioning
• Analytics and Intelligence
• Implementation
Health Workforce
• Employment Relations
• Health Workforce Chief Advisors
• Office of the Deputy Director-General
DHB Performance • DHB Planning and Accountability
Data and Digital • Security
• Audit and Compliance
Corporate Services
• Facilities (1FTE)
HNZ MHA Operating Model and High level Structure | Update | 38